Culture

Fewer people are getting arrested for marijuana possession in Washington state after legalization -- imagine that! -- Kansas legislators want to drug test teachers, a New Jersey heroin and opiates panel has recommendations, Russell Brand goes to Vienna, and more. Let's get to it:

Russell Brand speaks out for drug decriminalization at the CND in Vienna. (wikimedia.org)

Marijuana Policy

Oregon GOP Gubernatorial Candidate Says Legalize It. Republican gubernatorial candidate Tim Carr says he favors legalizing and taxing recreational marijuana use and would spend the proceeds on helping the homeless and others in need. Carr is one of six Republicans running in the primary to determine who takes on incumbent Democrat John Kitzhaber. He's not the front-runner; that distinction goes to state Rep. Dennis Richardson.

Washington State ACLU Reports Big Drop in Pot Arrests. Misdemeanor marijuana possession arrests plummeted last year, the ACLU of Washington reported today. There were just 120 such arrests last year after legalization went into effect, compared to 5,531 the year before. But black people are still getting arrested for pot possession more often. They're getting popped at a rate three times that of whites, the ACLU said.

Kansas School Teacher Drug Testing Bill Passes Senate. A bill that requires drug testing of school employees and affirms the firing of educators convicted of DUI, drug crimes, and other offenses passed the state Senate Tuesday. Senate Bill 335 was approved after Senate Democrats successfully offered an amendment that would subject members of the House and Senate to treatment requirements and financial sanctions mirroring those in state law for the unemployed or those on cash aid. The welfare drug testing law passed last year also included elected representatives, but contained no provisions for sanctioning them or requiring they seek help. The bill now goes to the House.

Heroin

Kentucky Omnibus Heroin Bill Stuck in House. A bill that would both enact harm reduction measures and crack down on heroin-selling offenses is stuck in the House Judiciary Committee. Senate Bill 5 would let drug dealers be charged with murder if the sale of Schedule I drugs results in death and increases penalties for high-volume heroin dealers. It also seeks increased Medicare funds for drug treatment, access to the overdose reversal drug naloxone, and a 911 Good Samaritan provision. The Senate passed the bill in January.

New Jersey Heroin Task Force Calls for Broad Reforms. A governor's task force on heroin and opiate use called for a wide array of reforms, saying it is "time to confront our demons." According to The Newark Star-Ledger, which obtained an advance copy, the panel's report calls for tighter prescription pill monitoring laws, changes in the state's insurance system to make treatment more available, and expanded use of drug treatment recovery communities.

Senior Mexican Anti-Drug Official Resigns. Manuel Mondragón y Kalb, Mexico's national security commissioner and one of the most senior officials in charge of the country's counternarcotics fight, has resigned "for personal reasons." The National Security Commission (CNS), which falls under the Interior Ministry, was created by President Enrique Peña Nieto in January 2013 to replace the Secretariat of Public Security. The CNS, which is in charge of the Federal Police, is behind schedule in its task to create a National Gendarmerie to bolster the country's counter-narcotics fight, which is one of Peña Nieto's campaign promises.

(This article was published by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also shares the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

The District of Columbia could legalize marijuana at the ballot box this year, Dr. Sanjay Gupta doubles down on his support for medical marijuana with a new CNN special tonight, the UN Commission on Narcotic Drugs meeting this week in Vienna is attracting a lot of attention, and more. Let's get to it:

Missouri Legalization Bill Gets Committee Hearing. A bill to legalize marijuana in the Show-Me State got a hearing in the House Crime Prevention and Public Safety Committee Monday. House Bill 1659, sponsored by Rep. Chris Kelly (D-Columbia), got a mixed reception in the hearing, with GOP lawmakers expressing skepticism. The committee took no vote and offered no timetable for further action.

Louisiana Marijuana Reform Advocates Rally on Capitol Steps in Baton Rouge. Although there is no legalization bill filed in Louisiana, legalization advocates rallied at the state capitol Monday to get their voices heard. The event was organized by Legalize Louisiana, which seeks to "decriminalize, legalize, and regulate marijuana" in the Bayou State. Although there is no legalization bill this year, there are bills to decriminalize and to allow for medical marijuana.

In New Crackdown, Los Angeles Shutters A Hundred Dispensaries. More than 100 dispensaries have shut down since Los Angeles started enforcing new rules restricting them, City Atty. Mike Feuer announced Monday. In addition to the rules prompting scores of closures, Feuer said city lawyers had successfully fended off a host of legal challenges. In one closely watched case, they prevented a dispensary from opening in Mar Vista, securing a permanent injunction before it could set up shop.

Minnesota Medical Marijuana Bill Stalled By Cops. A key lawmaker said Tuesday she doesn't see a path forward for legalizing medical marijuana after talks with law enforcement hit a standstill. Rep. Carly Melin (DFL-Hibbing) said she had conceded to virtually all demands from law enforcement over the weekend but was still unable to get their support for her bill, House File 1818. Melin said she had no choice but to postpone a House committee hearing that would have been lawmakers' second look at the issue. "Law enforcement won't support any bill that would result in helping any patients," Melin said in an interview with The Associated Press. "The governor has to get involved."

Drug Testing

Georgia Food Stamp Drug Test Bill Passes Senate Committee. A bill that would require food stamp recipients suspected of drug use to pass a drug test to receive benefits narrowly passed out of the Senate Health and Human Services Committee Monday. House Bill 772, sponsored by Rep. Greg Morris (R-Vidalia) has already passed the House. It's not clear if it now goes to another committee or to a Senate floor vote.

Prescription Opioids

West Virginia Senator Manchin Joins Call to Overturn FDA Approval of Zohydro. US Sen. Joe Manchin (D-WV) has joined the call for the FDA to overturn its recent approval of Zohydro, a single-ingredient hydrocodone drug approved for people suffering from chronic pain. It is the first ever single-ingredient drug to be approved by the FDA. Manchion joins Sen. Charles Schumer (D-NY) and a number of legislators, prosecutors, and medical groups seeking to reverse the decision. But the FDA and the drug's manufacturer say the drug is needed to treat chronic pain.

UN Drugs Meeting Opens after Historic Reforms Shatter Consensus on Drug Control System. The UN Commission on Narcotic Drugs (CND) opens its annual meeting this week after a year of historic reforms. This year’s meeting—which is taking place Vienna from March 13-21—is expected to be unusually contentious after a monumental 2013-2014. Unprecedented reforms have shaken the foundations of global drugs policy and set the stage for an explosive international debate. For live updates, check out the CND Blog.

Report Finds UN Stuck in Denial Over Marijuana Regulation. A new report from the Transnational Institute and the Global Drug Policy Observatory has been released in the run-up to the UN Commission on Narcotic Drugs meeting this week. The report, The Rise and Decline of Cannabis Prohibition: the History of Cannabis in the UN drug control system and options for reform, unveils the long and little-known history of cannabis regulation from the late 19th century when it was widely used for medical, ceremonial and social purposes to the post-WWII period when US pressure and a potent mix of moralistic rhetoric and unreliable scientific data succeeded in categorising cannabis as a drug with 'particularly dangerous properties' on a par with heroin in the 1961 Single Convention on Narcotic Drugs. It also brings the history up-to-date with more recent developments as an increasing number of countries have shown discomfort with the treaty regime's strictures through 'soft defections', such as turning a blind eye, decriminalization, coffee shops, cannabis social clubs and generous medical marijuana schemes. These have stretched the legal flexibility of the conventions to sometimes questionable limits. The report outlines specific options for reform and assesses their potential for success. These options include: WHO review and modification of cannabis scheduling; state parties amending the treaties; modifying the conventions 'inter se', e.g. between specific states only; or denunciation of the treaty and re-accession with a reservation (carried out recently by Bolivia in order to defend indigenous rights and the use of coca leaf in its natural form).

ENCOD Calls for UN to End the Drug War. The European Coalition for Just and Effective Drug Policies (ENCOD) will use the UN Commission on Narcotic Drugs this week to call on the UN to end the war on drugs. A delegation of five Encod members will join the debate inside the UN: Urki Goñi, chairman of Cannabis Social Club Urjogaberdea in the Basque Country, Spain, Doug Fine, author of 'Hemp Bound' and 'Too High To Fail: Cannabis & the New Green Economic Revolution', Dionisio Nuñez, Bolivian ex-minister of coca affairs, Janko Belin, Encod chairman and Joep Oomen, Encod coordinator. On Friday March 14 one of them will deliver a speech to the plenary meeting. ENCOD will also be reporting nightly from the sessions later this week on the ENCOD web site.

Legalization Won't Solve World's Drug Problem, UN Drug Chief Says.Yuri Fedotov, head of the UN Office on Drugs and Crime, told reporters Monday that while it is up to member states to decide "what needs to be done," legalization ain't it. "As the head of UNODC, I have to say that legalization is not a solution to the (world's) drug problem," Fedotov said. "It is very hard to say that this law (adopted by Uruguay's parliament) is fully in line with legal provisions of the drug control conventions," he added.

UN Drug Chief Praises Iran Drug Fight Despite Executions. Yuri Fedotov, head of the UN Office on Drugs and Crime, said Monday that Iran's anti-drug efforts were "very impressive" and that Iran "takes a very active role to fight against illicit drugs" even though human rights and harm reduction groups have criticized its frequent resort to the death penalty for drug offenders. Still, he added that UNODC opposes the death penalty and that he planned to raise the issue with Iranian leaders during the UN Commission on Narcotic Drugs meeting in Vienna this week.

Marijuana legalization in the District of Columbia hits a bump, the Epilepsy Foundation comes out for medical marijuana, India passes landmark access to pain medication legislation, and more. Let's get to it:

New Mexico House Approves Study of Legalization Effects. The state House late Wednesday passed a nonbinding memorial (bill) that calls for studying the effects of marijuana legalization in Colorado and Washington. Under the measure, the Legislative Finance Committee would conduct the study and report its findings later this year. The committee will be looking specifically at state revenue and agricultural production levels as well as addiction rates and the availability of law enforcement resources. The bill is House Memorial 38.

Medical Marijuana

Epilepsy Foundation Calls for Access to Medical Marijuana, Tells DEA to Back Off. "The Epilepsy Foundation supports the rights of patients and families living with seizures and epilepsy to access physician directed care, including medical marijuana. Nothing should stand in the way of patients gaining access to potentially life-saving treatment," said Epilepsy Foundation President and CEO Philip M. Gattone and Epilepsy Foundation Board of Directors Chairman Warren Lammert. "If a patient and their healthcare professionals feel that the potential benefits of medical marijuana for uncontrolled epilepsy outweigh the risks, then families need to have that legal option now -- not in five years or ten years. For people living with severe uncontrolled epilepsy, time is not on their side." The foundation said it was moved to act after getting repeated inquiries about the use of medical marijuana, especially high CBD cannabis oils. It also urged the DEA to get out of the way. Click on the link to read the press release.

Naloxone (Opioid Overdose Reversal Drug) Bills Move in Ohio, Wisconsin. Bills that would expand access to the opioid overdose reversal drug naloxone (Narcan) are moving in Ohio and Wisconsin. The Christian Science Monitor mentions these bills in a broader article on states moving to respond opioid overdoses. Click on the link to read the whole thing.

International

India's Rajya Sabha Passes Bill to Increase Access to Opiate Pain Medications. India's parliament has passed a bill that will ease access to opiate pain medications. The Narcotic Drugs and Psychotropic Substances (Amendment) Bill, 2014, was passed by the Rajya Sabha, or upper house Friday. It had passed the Lok Sabha, or lower house, the day before. The law will bring relief to thousands of cancer patients in the country who use opiates for acute and chronic pain relief. It had been pushed by the Indian Association for Palliative Care, among other groups.

Canada's Trailer Park Boys Say Don't Legalize It. Canada's cult TV and movie phenomenon, Trailer Park Boys, is back with a new sequel, Trailer Park Boys 3: Don't Legalize It. Ricky, Julian, Bubbles, and the rest of the crew have too much invested in their latest criminal pot growing scheme to put up with legal weed.

Seven Killed in Philippines Drug Raid. Philippines anti-drug police killed seven suspected drug dealers and arrested several more in a Friday raid on the outskirts of Davao City. "They put up a fight and were killed in the process," Mayor Rodrigo Duterte said here when asked about the deaths. Duterte has long been suspected of being behind extrajudicial killings in Davao City, an accusation the Aquino administration ally has repeatedly denied.

A bill has been filed to stop forcing the drug czar to oppose drug legalization, CBD medical marijuana bills continue to get attention, and there are big doings south of the border, and more. Let's get to it:

Russell Brand helped push British petition over the top. (flickr.com/photos/evarinaldiphotography/)

High Times, Westword Sue Colorado Over Marijuana Advertising Restrictions. Marijuana magazine High Times and Denver alternative weekly Westword filed a lawsuit in federal court Monday challenging Colorado's restrictions on advertising for legal marijuana. The state's rules allow pot businesses to advertise only in adult-oriented publications for which "no more than 30% of the publication's readership is reasonably expected to be under 21." The lawsuit argues that the restrictions are an unconstitutional contravention of free speech.

Hundreds Pack Oklahoma Capitol for CBD Medical Marijuana Hearing. Demonstrators called for marijuana legalization outside as hundreds of people jammed into the state capitol for a hearing on CBD medical marijuana. Dramatic and moving testimony was heard from family members of children suffering seizure disorders who might be helped by access to CBD cannabis oils.

Cincinnati Gets Its First Needle Exchange Program. The first needle exchange program in the Southwest Ohio/Northern Kentucky region is open for business. The Cincinnati Exchange Program becomes the third in Ohio, with others already operating in Cleveland and Portsmouth. The needle exchanges have been proven to reduce the spread of HIV, Hep C, and other blood-borne infectious diseases.

Prescription Drugs

Prescription Drug Database Bill Wins Missouri House Vote. A bill that would establish a prescription drug database has won a vote in the House, but senators, citing privacy concerns, said there is little chance of it moving forward in their chamber. The bill would create an electronic database managed by the state health department that would share information about prescriptions, patients, and doctors. The bill is House Bill 1133.

International

Mexico City Decriminalization, Regulation Bill and Mexican National Drug Reform Bill Introduced Today. In Mexico City, legislators for the federal district introduced a bill to decriminalize the possession of up to five grams of marijuana and remove the option of incarceration for possession of small amounts of other drugs. The bill would also allow for limited regulated marijuana sales. The second, national, bill would reschedule marijuana and allow for its medical use. Look for a Chronicle feature article on this soon.

Dark Web Drug Sales Site Busted. German and Dutch authorities have arrested five men in a sting directed at an internet drug sales portal. The men were connected to Black Market Reloaded and its successor web site, Utopia. Undercover police purchased drugs and weapons through the web sites, they said, and seized computers, hard drives, USB sticks, and a Bitcoin wallet containing $680,000 worth of the electronic currency.

More Than 100,000 Sign British Petition for Review of Drug Laws. Green Party MP Caroline Lucas set up an online petition urging the British government to order a cost-benefit analysis and impact assessment of British drug laws within the next year. It has now achieved the benchmark of 100,000 signatures, which means it must be addressed by the Backbench Business Committee. Sign-ons accelerated after actor and comedian Russell Brand joined with the online campaign group Avaaz to encourage its 1.1 million members to sign up.

The news last Sunday that acclaimed actor Phillip Seymour Hoffman had died of an apparent heroin overdose has turned a glaring media spotlight on the phenomenon, but heroin overdose deaths had been on the rise for several years before his premature demise. And while there has been much wailing and gnashing of teeth -- and quick arrests of low-level dealers and users -- too little has been said, either before or after his passing, about what could have been done to save him and what could be done to save others.

cooking heroin (wikimedia.org)

There are proven measures that can be taken to reduce overdose deaths -- and to enable heroin addicts to live safe and normal lives, whether they cease using heroin or not. All of the above face social and political obstacles and have only been implemented unevenly, if at all. If there is any good to come of Hoffmann's death it will be to the degree that it inspires broader discussion of what can be done to prevent the same thing happening to others in a similar position.

Hoffman, devoted family man and great actor that he was, died a criminal. And perhaps he died because his use of heroin was criminalized. Criminalized heroin -- heroin under drug prohibition -- is of uncertain provenance, of unknown strength and purity, adulterated with unknown substances. While we don't know what was in the heroin that Hoffman injected, we do know that he maintained his addiction and went to meet his maker with black market dope. That's what was found beside his lifeless body.

In a commentary published by The Guardian, actor Russell Brand, a recovered heroin addict, laid the blame for Hoffman's demise on the drug laws. "Addiction is a mental illness around which there is a great deal of confusion, which is hugely exacerbated by the laws that criminalise drug addicts," Brand wrote, calling prohibitionists' methods "so gallingly ineffective that it is difficult not to deduce that they are deliberately creating the worst imaginable circumstances to maximise the harm caused by substance misuse." As a result, "drug users, their families and society at large are all exposed to the worst conceivable version of this regrettably unavoidable problem."

We didn't always treat our addicts this way. Even after the passage of the Harrison Act in 1914, doctors continued for years to prescribe maintenance doses of opiates to addicts -- and hundreds of them went to jail for it as the medical profession fought, and ultimately lost, a battle with the nascent drug prohibition bureaucracy over whether giving addicts their medicine was part of the legitimate practice of medicine.

The idea of treating heroin addicts as patients instead of criminals was largely vanquished in the United States, but it never went away -- it lingers with methadone substitution, for example. But other countries have for decades been experimenting with providing maintenance doses of opioids to addicts, and to good result. It goes by various names -- opiate substitution therapy, heroin-assisted theatment, heroin maintenance -- and studies from Britain and other European countries, such as Germany, the Netherlands, and Switzerland, as well as the North American Opiate Medications Initiative (NAOMI) and the follow-up Study to Assess Long-Term Opiate Maintenance in Canada have touted its successes.

Those studies have found that providing pharmaceutical grade heroin to addicts in a clinical setting works. It reduces the likelihood of death or disease among clients, as well as allowing them to bring some stability and predictability to sometimes chaotic lives made even more chaotic by the demands of addiction under prohibition. Such treatment has also been found to have beneficial effects for society, with lowered criminality among participants and increased likelihood of their integration as productive members of society.

The dry, scientific language of the studies obscures the human realities around heroin addiction and opioid maintenance therapy. One NAOMI participant helps put a human face on it.

"I want to tell you what being a participant in this study did for me," one participant told researchers. "Initially it meant 'free heroin.' But over time it became more, much more. NAOMI took much of the stress out of my life and allowed me to think more clearly about my life and future. It exposed me to new ideas, people (staff and clients) that in my street life (read: stressful existence) there was no time for."

"After NAOMI, I was offered oral methadone, which I refused. After going quickly downhill, I ended up hopeless and homeless. I went into detox in April 2007, abstained from using for two months, then relapsed. In July 2008 I again went to detox and I am presently in a treatment center... I am definitely not "out of the woods" yet, but I feel I am on the right path. And this path started for me at the corner of Abbott and Hastings in Vancouver... Thank you and all who were involved in making NAOMI happen. Without NAOMI, I wouldn't be where I am today. I am sure I would be in a much worse place."

Arnold Trebach, one of the fathers of the drug reform in late 20th Century America, has been studying heroin since 1972, and is still at it. He examined the British system in the early 1970s, when doctors still prescribed heroin to thousands of addicts, and authored a book, The Heroin Solution, that compared and contrasted the US and UK approaches. Later this month, the octogenarian law professor will be appearing on a panel at the Vermont Law School to address what Gov. Peter Shumlin (D) has described as the heroin crisis there.

Phillip Seymour Hoffman (wikimedia.org)

"The death of Phillip Seymour Hoffman is a tragedy all the way around," Trebach told the Chronicle. "It's a bad idea to use heroin off the street, and he shouldn't have been doing that."

That said, Trebach continued, it didn't have to be that way.

"If we had had a sensible system of dealing with this, he would have been in treatment under medical care," he said. "If he was going to inject heroin, he should have been using pharmaceutically pure heroin in a medical setting where he could also have been exposed to efforts to straighten out his personal life, and he could have access to vitamins, weight control advice, and the whole spectrum of medical care. And if he had had access to opioid antagonists, he could still be alive," he added.

While Hoffman may have made bad personal choices, Trebach said, we as a society have made policy choices seemingly designed to amplify the prospects for disaster.

"This is a sad thing. He is just another one of the many victims of our barbaric drug policy," he said. "This was a totally unnecessary death at every level. He shouldn't have been using, but we should have been taking care of him."

The stuff ought to be legalized, Trebach said.

"I'm an advocate of full legalization, but if we can't go that far, we need to at least provide social and psychological support for these people," he said. "And even if we were to decriminalize or legalize, I would still want to figure out ways to provide support and love and kindness to people using the stuff. I advise you not to do it, but if you're going to use it, I want to keep you alive. I remember talking to people from Liverpool [a famous heroin maintenance clinic covered in the '90s by Sixty Minutes, linked above] about harm reduction around heroin use back in the 1970s. One of the ladies said it is very hard to rehabilitate a dead addict."

"There are plenty of things we can be doing," said Hilary McQuie, Western director for the Harm Reduction Network, reeling off a list of harm reduction interventions that are by now well-known but inadequately implemented.

"We can make naloxone (Narcan) more available. We need better access to it. It should be offered to people like Hoffman when they are leaving treatment programs, especially if they've been using opiates, just as a safeguard," she said. "Having treatment programs as well as harm reduction programs distribute it is important. We can cut the overdose rate in half with naloxone, but there will still be people using alone and people using multiple substances."

There are other proven interventions that could be ramped up as well, McQuie said.

"Safe injection sites would be very helpful, so would more Good Samaritan overdose emergency laws, and more education, not to mention more access to methadone and buprenorphine and other opioid substitution therapies (OST)," she said, reeling off possible interventions.

Dr. Martin Schechter, director of the School of Population and Public Health at the University of British Columbia in Vancouver, knows a thing or two about OST. The principal study investigator for the NAOMI and the follow-up SALOME study, Schechter has overseen research into the effectiveness of treating intractable addicts with pharmaceutical heroin, as well as methadone. The results have been promising.

"What we're using is medically prescribed pharmaceutical diacetylmorphine, the active ingredient in heroin," he explained. "It's what you have when you strip away all the street additives. This is a stable, sterile medication from a pharmaceutical manufacturer. We know the precise dose tailored for each person. With street heroin, not only is it adulterated and injected in unsterile situations, but people really don't know how strong it is. That's probably what happened to Mr. Hoffman."

Naloxone (Narcan) can reverse opiate overdoses (wikimedia.org)

In NAOMI, 90,000 injections were administered to study participants, and only 11 people suffered overdoses requiring medical attention.

"Never did we have a fatal overdose," Schechter said. "Because it was in a clinic, nurses and doctors are right there. We administer Narcan (naloxone), and they wake up."

Heroin maintenance had even proven more effective than methadone in numerous studies, Schechter said.

"There have been seven randomized control trials across Europe and in Canada that have shown for people who have already tried treatments like methadone, that medically prescribed heroin is more effective and cost effective treatment than simply trying methadone one more time."

Those studies carry a lesson, he said.

"We have to start looking at heroin from a medicinal point of view and treat it like a medicine," he argued. "The more we drive its use underground, the more overdoses we get. We need to expand treatment programs, not only with methadone, but with medically prescribed heroin for people who don't respond to other treatments."

Safe injection sites are also a worthwhile intervention, Schechter said, although he also noted their limitations.

"Injecting under supervision is much safer; if there is an overdose, there is prompt attention, and they provide sterile equipment, reducing the risk of HIV and Hep C," he said. "But they are still injecting street heroin."

He would favor decriminalizing heroin possession, too, he said.

Harm reduction measures, opioid maintenance treatments, and the like are absolutely necessary interventions, said McQuie, but there is a larger issue at hand, as well.

"We still need to look at the overall issue of the stigmatization of drug users," she said. "People aren't open about their use, and that puts them in a more dangerous situation. It's really hard in a criminalized environment."

Stigmatization means to mark or brand someone or something as disgraceful and subject to strong disapproval. Defining an activity, such as heroin possession, as a crime is stigmatization crystallized into the legal structures of society itself.

"The ultimate harm reduction solution," McQuie argued, "is a regulated, decriminalized environment where it is available by prescription, so people know what they're getting, they know how much to use, and it's not cut with fentanyl or other deadly adulterants. People wouldn't have to deal with all the collateral damage that comes from being defined as criminals as well as dealing with the consequences of their drug use. They could deal with their addictions without having to worry about losing their homes, their families, and their freedoms."

While such approaches have a long way to go before winning wide popular acceptance, policymakers should at least be held to account for the consequences of their decision-making, McQuie said, suggesting that the turn to heroin in recent years was a foreseeable result of the crackdown on prescription opioid pain medication beginning in the middle of the last decade.

"They started shutting down all those 'pill mills' and people should have anticipated what would happen and been ready for it," she said. "What we have seen is more and more people turning to injecting heroin, but nobody stopped to do an impact statement on what would be the likely result of restricting access to pain pills."

The impact can be seen in the numbers on heroin use, addiction, and overdoses. While talk of a "heroin epidemic" is overblown rhetoric, the number of heroin users has increased dramatically in the past decade. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of past year users grew by about 50% between 2002 and 2011, from roughly 400,000 to more than 600,000. At the same time, the number of addicted users increased from just under 200,000 to about 370,000, a slightly lesser increase.

If there is any good news, it is that, according to the latest (2012) National Household Survey of Drug Use and Health, the number of new heroin users has remained fairly steady at around 150,000 each year for the past decade. That suggests, however, that more first-time users are graduating to occasional and sometimes, dependent user status.

And some of them are dying of heroin overdoses, although not near the number dying from overdoses from prescription opioids. Between 1999 and 2007, heroin deaths hovered just under 2,000, even as prescription drug deaths skyrocketed, from around 2,500 in 1999 to more than 12,000 just eight years later. But, according to the Centers for Disease Control, by 2010, the latest year for which data are available, heroin overdose deaths had surpassed 3,000, a 50% increase in just three years.

While the number of heroin overdose deaths is still but a fraction of those attributed to prescription opioid overdoses and the numbers since 2010 are spotty, the increase that showed up in 2010 shows no signs of having gone away. Phillip Seymour Hoffman may be the most prominent recent victim, but in the week since his death, another 50 or 60 people have probably followed him to the morgue due to heroin overdoses.

There are ways to reduce the heroin overdose death toll. It's not a making of figuring out what they are. It's a matter of finding the political and social will to implement them, and that requires leaving the drug war paradigm behind.

The tragic death of actor Philip Seymour Hoffman yesterday has prompted expressions of grief and of praise for his talent. It also, naturally, has prompted discussions of addiction, the impact of pain pill prescriptions on the addicted, even of pain pill restrictions causing more people to turn to heroin.

While the latter raises the question about whether different drug policies could make things safer or less damaging or risky for heroin addicts, I haven't heard that question directly raised in the media. Although we don't know how Hoffman would have fared under a different system -- a system that had more options available, we do have information from places that do offer more options, and they are worth examining.

One of those options is heroin maintenance programs (also known now as heroin assisted treatment, or HAT). The most famous such program operated in Liverpool, England, before the conservative Thatcher government, encouraged by the Reagan administration (so we heard), shut it down. But HAT programs current operate in Switzerland, The Netherlands, Germany, Denmark, and the Canadian cities of Vancouver and Montreal. Patients in such programs receive a supply of pharmaceutically-produced heroin from a clinic (for free, though one can infer similar benefits if the heroin were merely cheap). They regularly access health services as a part of their participation. Those who need to inject the drug to relieve their cravings receive instruction on how to do so without damaging their veins, and heroin is made available in other forms as well.

A 2009 paper by leading drug policy researcher Peter Reuter, written for The Abell Foundation in Baltimore, reviewed research done in three of those countries. According to Reuter, Switzerland found a decrease in criminal involvement from 70% of the patients down to 10% after 18 months; and an increase in employment, from 14% to 32%. The health safety results were particularly impressive, including decreased contact with the street drug scene, and with very few adverse events or safety issues.

Many of those findings relate more to indigent addicts than they would to a famous actor. But the final point seems key, very few "adverse events" (e.g. overdoses and so forth) or safety issues, in any of the programs. Again, we don't know how Hoffman would have fared if he had entered a heroin maintenance program instead of buying it on the street. For that matter, we don't know if under legalization, broad or just for the addicted, whether Hoffman would have accessed such services in time, or chose to access them at all. But we know that many people do access these services in the countries that offer them, and that very few of the patients enrolled suffer overdose.

More generally, by prohibiting heroin, even for people who are already addicted to it, we prevent a whole class of possible approaches from every being taken to try to help people -- a whole set of options that people with substance abuse problems might be able to use to manage their problems -- to literally save their lives.

In the meanwhile, there are things to do that are legal even now, at least in a few states that have moved forward with them, with no federal laws standing in the way. These are Good Samaritan policies, that protect people from criminal liability when they seek help in an overdose situation; and use of the antidote medication for heroin overdoses, Naloxone. Meghan Ralston wrote about these in an oped yesterday.

We can also improve the debate. It's not enough to talk about the challenges of addiction and the risk of relapse people can face their entire lives, important as that is. It's a good start that people are starting to recognize the unintended consequences of the pain pill crackdown. But that isn't enough either. It's also important to take the next logical step in the argument, and rethink prohibition.

Big congratulations are in order for our German brethren. They have scored a major publicity and resource coup that will definitely help them advance the cause.

Cannabis activist George Wurth of the German Hemp Association (Deutscher Hanf Verband) has won a million-Euro prize to expand the group's legalization activism from the German television program Millionaire Choice (Millionaerswahl).

Millionaire Choice is a reality TV program where self-selected contestants compete in a multi-stage process of elimination to see whose idea will be funded. The cross-media campaign is determined by the vote of viewers.

"The madness! George has won. We are completely overwhelmed. The work of 10 years has now finally paid off. Along with the events in the US and Uruguay, this can be the starting point for the hemp movement gaining strength in Germany," the group's home page exclaimed.

"January 25, 2014 will be long remembered by the DHV and raise the German hemp scene to a new level," the group said in a weekend press release. "When we decided to participate in the Millionaire Choice, we would not have expected this tremendous success. We thank you all for your votes and your infectious enthusiasm. You have voted for George, and without you this huge success would not have been possible."

The marijuana issue continues hot and heavy, one of our favorite authors is nominated for an award, harm reduction bills move in Wisconsin, and the US Sentencing Commission wants to cut drug sentences. And more. Let's get to it:

Colorado Republicans File Bill to Ban Food Stamps in Marijuana Shops. File under: solutions in search of problems. There is no evidence that anyone has ever used a food stamp EBT card to purchase marijuana products, but that hasn't stopped a handful of GOP state legislators to file a bill to outlaw it. "We need this bill, if for nothing else, as a statement," said Rep. Jared Wright (R-Grand Junction). "We shouldn't be enabling anyone to buy a substance that is banned under federal law. It's not a good use of taxpayer money," he said. The bill is Senate Bill 37.

No Marijuana Legalization Bill for Ohio This Year. The only Ohio legislator to push for marijuana legalization last year won't try it again this year. Rep. Bob Hagan (D-Youngstown) said he had no plans to introduce a measure this year after last year's effort to pass a resolution to let residents vote on the issue was sidelined.

Washington Congressman Urges Feds to Act Quickly on Marijuana Banking. Rep. Denny Heck (D-Washington) Friday called on federal regulators to move swiftly to resolve the issue of financial institutions being able to do business with legal marijuana businesses. In a statement, the coauthor of pending federal legislation that would do just that said that "it is urgent federal regulators come to a resolution on this issue as soon as possible."

Powerful Maryland Pol Comes Out for Marijuana Legalization. Delegate Maggie McIntosh (D-Baltimore) has joined the list of powerful state legislators calling for marijuana legalization. She said legalization is one of "the biggest, most important issues" facing the General Assembly this year. She joins Senate President Thomas Miller (D) and Democratic gubernatorial candidate Heather Mizeur in supporting legalization, but Gov. Martin O'Malley (D) and House Speaker Michael Busch (D) both oppose it.

Steny Hoyer Opposes Marijuana Legalization in Maryland. US House Minority Whip Steny Hoyer (D-MD) said Thursday he opposes legalizing pot in the state. "I'm not a proponent of legalizing marijuana," he said. "As I talked to people who deal with drug abuse issues, with rehabilitation issues, I became convinced that marijuana was, in fact, a threshold drug and it would lead to the use of harder, very harmful drugs," he added.

Florida House Committee Chair Will Propose Bill to Legalize High CBD Strains for Seizures. Rep. Matt Gaetz (R-Shalimar), chair of the House Criminal Justice Subcommittee, said Thursday he would introduce a bill to allow for the medical use of marijuana strains that are high in CBDs. The vow came after a heart-wrenching hearing from parents of children who suffer seizure disorders, who called on the legislature to legalize strains such as "Charlotte's Web."

Asset Forfeiture

Utah Attorney General Sees Asset Forfeiture as Tool against Drug Legalizing Attorneys. After changes to undo asset forfeiture reforms approved by voters in 2000 snuck through the state legislature last year came under this week, Utah Attorney General Sean Reyes issued a brief defending the new law. But a bullet point justifying a new cap on attorneys' fees for people who successfully defend their property is setting off alarms among First Amendment advocates. "By setting a limit on attorney's fees it will take away the incentive for attorneys who actively promote the legalization of drugs in the state of Utah from soliciting clients who are engaged in criminal activity," the attorney general's brief said. Click on the link for a lengthier critique.

Drug Testing

Welfare Drug Testing Bill Coming Back in Indiana. House Speaker Brian Bosma (R-Indianapolis) said Thursday that while welfare drug testing legislation is not part of the House Republican agenda, a pending bill to do just that is "one we're going to enthusiastically endorse and move forward on." The bill, which passed the House, but not the Senate, last year, would require drug testing of welfare recipients based on some form of reasonable suspicion.

Harm Reduction

Push On to End Needle Exchange Ban in Federal Funding Bill. Harm reduction and public health advocates are urging lawmakers to lift the prohibition on the use of federal funds to pay for needle exchange programs. The battlefield is the conference committee that will reconcile House and Senate budget bills. The Senate version had language that included funding for needle exchanges, but the GOP-led House is expected to oppose it.

Wisconsin Overdose 911, Naloxone Bills Pass Assembly Committee. A bill to provide limited legal immunity to people who notify authorities of an overdose passed the Assembly Criminal Justice Committee Thursday. So did a bill that would allow first responders to carry and use the overdose reversal drug naloxone. Both now goes to the full Assembly, which should vote on them Tuesday. The bills have the backing of Attorney General JB Van Hollen (R) and are expected to sail through the Senate as well.

US Sentencing Commission Suggests Lowering Drug Guideline Sentences. The US Sentencing Commission voted Thursday to publish proposed federal drug sentencing guideline amendments that would include lowering guideline sentences for drug trafficking offenses. The amendments would reduce drug trafficking sentences by about 11 months, leading to a reduction in the federal prison population of more than 6,000 prisoners five years after taking effect. The commission is now seeking public comment on the proposal.

International

Jamaica Marijuana Growers to Organize. Jamaican legalization activists and marijuana growers will form a Cannabis Future Growers and Producers Association as part of a major conference next week. The "Going Forward -- Legalize It" conference is organized by the Ganja Law Reform Coalition, the Cannabis Commercial and Medicinal Research Task Force, and the National Alliance for the Legalization of Ganja, and hopes to help lay the groundwork for a legal marijuana industry on the island.

Canada's SensibleBC Sees 2014 as a Building Year. After an effort to put marijuana reform on the provincial ballot via an initiative faltered last year, Sensible BC leader Dana Larsen said this year would be a year of building momentum, training canvassers, and spreading the message of marijuana legalization. Larsen will also be touring the province this spring and summer to build support.

Actor Michael Douglas gave a tribute to our friend Mike Gray at the memorial service in Los Angeles this week. He talked about first working with Mike on the movie The China Syndrome, and about MIke's work on drug policy reform and how the drug war has affected him and his family. You can listen to it on the Drug Truth Network here.

It was recorded by Doug McVay, who attended the memorial with Common Sense for Drug Policy. Mike was the board chair of CSDP, and Doug and I are both board members.

The United States and the United Kingdom seem to be in two quite different places when it comes to marijuana and marijuana policy. On this side of the Atlantic, two states have legalized the weed, and in all likelihood, more will follow in 2014 and more yet in 2016. Meanwhile, medical marijuana continues to expand, and states that aren't quite ready for legalization are moving toward decriminalization.

National polls here are consistently showing that support for marijuana legalization has crossed the threshold into majority territory, weed-smoking is now the stuff of casual comment instead of horrified gasps, and, in what could the clearest sign of marijuana's growing acceptance, profit-minded entrepreneurs are beginning to line up for a chance to grab the grass ring. It's almost, but not quite, as if we have already won, and all that's left is clearing the last holdouts of pot prohibition.

On the other side of the Atlantic, things seem to be heading in the opposite direction. Heeding the advice of its drug experts (an increasingly rare thing there), Britain in effect decriminalized marijuana in 2004, but backtracked four years later, pushing it a notch back up its dangerous drug schedules. The British press is full of reports of raids on "cannabis factories," or what we would call indoor gardens, and replete with the sort of Reefer Madness nonsense that would make Harry Anslinger blush.

Fertilizer becomes "poison cannabis chemicals," the deadly "skunk" turns kids into homicidal "feral youths," and anti-cannabis crusade victims regularly appear before the courts to go through the self-abasing ritual of explaining that they should have mercy because their cannabis addiction ruined their lives. They know what they're supposed to say. When it comes to marijuana, in feels like 1963 in Britain instead of 2013.

Cannabis Nation and Marijuanamerica certainly reflect those differences in style as well as substance, even if they don't explain them. (And why should they? Neither makes a pretense at being a comparative study.) The former is a stately academic review of British pot policy in the last century, relying heavily on governmental files, diplomatic archives, commission reports, and police arrest records, while the latter is an impressionistic journey through American weed's Wild West, relying heavily on interviews, first-person reporting, some participatory journalism, and copious amounts of the chronic itself.

Despite their differences in tone and subject matter, both are worthwhile contributions to the rapidly increasing literature around marijuana and marijuana law reform. Cannabis Nation is authored by respected British drug historian James Mills and is the sequel to his 2003 Cannabis Britannica, which traced Britain's involvement with the herb from 1800 into the beginning of the 20th Century. In this second volume, Mills not only tracks the emergence of marijuana consumption in the metropole, but also the impact of Britain's legacy as a colonial power on its encounter with the weed.

There are parallels with the American experience, but also differences. In both countries, marijuana was the province of outsiders. Here, it was Mexicans and black jazz musicians who were the original consumers; in Britain, as Mills shows, it was South Asian, Caribbean, and Arab colonial subjects who brought pot-smoking to Albion. And before the aftermath of World War II, when Commonwealth citizens flooded into Britain, marijuana use was rare indeed. Mills shows the pre-war pot arrests were almost nonexistent, counted in the dozens annually, and almost entirely of merchant seamen of Arab or Indian descent enjoying their shore leave.

It was only in the post-war era that British marijuana consumption began to spread rapidly, first among the Commonwealth emigrants, for whom its use was long-engrained in their home cultures, and then among working- and middle-class Anglo-Saxon youth. By the 1960s, the issue of marijuana exploded with the arrest and jailing of Rolling Stones guitarist Keith Richard and subsequent campaigns for liberalization led by the Beatles and other counter-cultural figures. But Mills downplays the importance of the counter-culture rebellion, arguing that for many young British consumers, marijuana was no more (and no less) than something to get intoxicated with, not a token of cultural revolt.

In fact, the British marijuana reform movement gets relatively short shrift, as Mills concentrates on the doings of the politicians, ministries and constabularies. It is worth noting that, thanks to the drug diplomacy in the era of the League of Nations, Britain not only got a broad understanding of the plant's widespread use (British India lobbied hard for a relaxed approach, while British Egypt lobbied equally hard for a tough prohibition), but British police were mobilized to police marijuana early -- before there was any consumption to speak of.

One of Mills' key points is that nearly a century later, the police continue to play the key role in British pot policy. In the wake of the 1960s' pot controversies, politicians adopted the "British compromise," maintaining existing marijuana prohibition, but leaving the level and intensity of enforcement up to the police. As he shows, with politicians treating marijuana as a political football, that's still the case. Such a stratagem may work for the police, less so for marijuana growers and consumers, but it raises the question of whether law enforcers should be de facto policy-makers.

Overall, Cannabis Nation is a key contribution to the history of British pot politics, an academic treatise that is also quite readable and provocative, and one that disentangles the political and social forces behind marijuana use and reform in Britain. Given its $65 cover price, though, you're probably going to want to read it at your university library, or else hope that an affordable paperback edition appears.

Alfred Nerz inhabits a different world from James Mills. His Marijuanamerica is only among the most recent of dozens of popular accounts of the reefer revolution sweeping the US, and he traverses lots of familiar territory: He attends Oaksterdam University, interviews Richard Lee and Harborside Health Center's Steve DeAngelo, then heads for Humboldt County to smell the revolution for himself.

Amidst his travels, Nerz takes detours to address the issues around marijuana use -- is it helpful or harmful? What are its physical effects? Is it addictive? And should I quit smoking so much? -- and does so with verve, wit, and an engaging way with the science.

But what makes Marijuanamerica stand out in an increasingly crowded field is Nerz's own story of getting involved with California marijuana "outlaws." The book opens with him cruising eastbound down Interstate 80 just outside of Omaha with 100 pounds of weed in the trunk and a Nebraska State Patrol trooper on his tail. For someone carrying a personal pot stash down the nation's interstates, such an encounter is frightening; for someone carrying several felonies worth, it is absolutely terrifying. You'll have to buy the book to discover how that experience turned out.

In Northern California, a mightily stoned Nerz managed to hook up with a marijuana grower and distributor nicknamed Buddha Cheese, spend time at some of his grow sites scattered throughout the Emerald Triangle and the Sierra, and get a very close-up look at outlaw marijuana production without even the pretense of it being destined for the medical marijuana market. It's a sketchy, criminal scene, with lots of riff-raff and shady characters, just as one would expect in an underground criminal economy. It's a load of Buddha Cheese's product Nerz is driving to the East Coast, hoping to pocket $200 a pound for his troubles, a nifty $20,000 for toting his hundred-pound load. (Given the pot glut and dropping prices on the West Coast, getting the weed to the other coast can be the difference between $2,000 a pound at home and $6,000 a pound in New York or Philadelphia.)

Nerz's sojourn with the outlaws is eye-opening and somewhat disturbing, but also refreshing. There have been an awful lot of words written about medical marijuana, with its noble purveyors working to alleviate human suffering. And most of them are true. But California also produces one hell of a lot more pot than even its wide-open medical marijuana market can absorb, and so do growers in Colorado, Oregon, Washington, and other medical marijuana states. It's the All-American combination of enthusiasm for a wonderful plant that gets you nicely high, the desire to stick it to "the man," and the impulse to get rich quick. That's been part of America's pot culture for the past half-century at least, and it's nice to get past the sanctimony of medical marijuana and back to the outlaws.

You will want to read Cannabis Nation if you have a serious interest in the history, politics, and diplomacy of marijuana in England, and you'll have fun doing so. You don't need to be nearly as serious with Marijuanamerica, and you'll most likely have more fun, especially hanging out with those shady pot outlaws and Nerz himself. But both would make nice additions to your drug literature bookshelf.